Many patients with lung cancer in the United States received no treatment or less intensive treatment than the minimal lung cancer treatment recommended by guidelines from the National Comprehensive Cancer Network (NCCN). Disparities between guideline-concordant treatment and what patients received were particularly prominent in older patients and in non-Hispanic black patients. These study results were published in Annals of the American Thoracic Society.

To evaluate adherence to the minimal lung cancer treatment recommended by the NCCN, researchers assessed 441,812 cases of lung cancer in the National Cancer Database diagnosed between 2010 and 2014.

Although the majority of patients (62.1%) received guideline concordant treatment (range across clinical subgroups, 50.4-76.3), approximately 1 in 5 patients (21.6%) received no treatment at all (range, 10.3-31.4). An additional 16.3% received less intensive treatment than recommended (range, 6.4-21.6).

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Across all subgroups of lung cancer, conventionally fractionated radiotherapy only was among the most common less intensive therapies (range, 2.5%-16.0%). For the nonmetastatic subgroup, chemotherapy alone was among the most common less intensive therapies (range, 1.2-13.7%), as was conventionally fractionated radiotherapy and chemotherapy for the localized non-small cell lung cancer subgroup.

Treatment aligning with NCCN guidelines became less likely the older patients were, even when adjusting for covariates. The adjusted odds ratio (aOR) for patients 80 years and older compared with patients younger than 50 years was 0.12 (95% confidence interval [CI], 0.12-0.12), with this disparity persisting across all subgroups.

Furthermore, non-Hispanic blacks were less likely to receive treatment that adhered to NCCN guidelines than non-Hispanic whites (aOR = 0,78; 95% CI, 0.76-0.80). Although this disparity persisted across all clinical subgroups, it was statistically nonsignificant for extensive-disease small cell lung cancer.

“[W]e show that elderly patients and non-Hispanic Blacks are less likely to receive guideline-concordant treatment across most clinical subgroups of lung cancer despite adjusting for relevant patient, tumor, and health care provider characteristics. This knowledge may be used to target interventions for improving the rate of lung cancer cases that receive guideline-concordant treatment and to reduce disparities,” concluded the authors.

Reference

Blom EF, ten Haaf K, Arenberg DA, de Koning HJ. Disparities in receiving guideline-concordant treatment for lung cancer in the United States [published online November 1, 2019]. Ann Am Thorac Soc. doi: 10.1513/AnnalsATS.201901-094OC